This proposal describes an experiment which will investigate the relationship of continuing medical education (CME) to the effectiveness of medical audit as a measure of physician competence. A pilot study has shown that educational items presented through a CMA program conducted prior to an audit are incorporated in the criteria developed for the audit. This study will test the hypothesis that these criteria are better detectors of performance deficiencies than are criteria created in the usual manner (without prior CME). The experiment will take place in community hospitals in cooperation with two local Professional Standards Review Organizations (PSRO's). A list of audit topics will be submitted to each hospital for approval. Half of the audits selected randomly from the approved list will be preceded by CME on the topic. The remaining audits will be done without prior CME. Measurement of the effect of the intervention will be through use of a "detection effectiveness" index, based on number of deficiencies in care and variations from criteria identified by the audits. Statistical tests will be performed to determine the significance of any observed differences and the impact of institutional and topic-related parameters on audit sensitivity. Improving the ability of audit to detect educational deficiencies will provide valuable direction for future public policy decisions on mandatory recertification of physicians and for PSRO involvement in CME and medical audit.